Open Draft Would Widen Pregnancy Hypertensive Disorder Screening
Comment Now on Call for Blood Pressure Checks at Every Prenatal Visit
Feb. 28, 2023, News Staff — Comments are open on an updated draft recommendation that would expand screening for hypertensive disorders of pregnancy.
The draft of this B-grade recommendation from the U.S. Preventive Services Task Force calls for screening for hypertensive disorders using blood pressure measurements at every prenatal visit throughout pregnancy. This marks an expansion from the task force’s previous recommendation on the topic, which focused on screening pregnant women for preeclampsia.
The new draft recommends screening to detect a variety of conditions, including gestational hypertension, eclampsia and chronic hypertension (with or without superimposed preeclampsia). It applies to pregnant patients without hypertension diagnosed before 20 weeks of gestation.
“Hypertensive disorders of pregnancy are among the leading causes of serious complications and death for pregnant people in the United States,” family physician and task force member Esa Davis, M.D., M.P.H., said in a USPSTF bulletin. “Fortunately, measuring blood pressure at each prenatal visit is an effective way to screen for these conditions so pregnant people can receive the care they need.”
From 2016 to 2018, HDPs were responsible for 6.8% of all pregnancy-related deaths in the United States. U.S. data indicate that the prevalence of HDPs has increased from about 530 cases per 10,000 delivery hospitalizations in 1993 to 1,021 cases per 10,000 in 2016-2017.
Three Types of Screening Reviewed
The task force reviewed the effectiveness of three screening approaches:
- home blood pressure measurement as a supplement to or replacement for office-based measurement in prenatal care;
- prenatal screening visit schedules that varied by timing and the number of blood pressure measurements taken over the course of pregnancy; and
- indicated screening, rather than routine screening, to detect proteinuria.
The USPSTF found the different approaches neither reduced nor increased diagnoses of HDPs. The task force also said there was not enough evidence that any other approach is more accurate or effective than regular office-based blood pressure measurements.
Story Highlights
Closing the Gap on Inequities
While the task force said blood pressure measurements should be taken at each prenatal care visit, it added that screening for hypertensive disorders alone is not enough to reduce health outcome inequities. Reaching that goal will require adequate prenatal followup visits, surveillance and evidence-based responses to signs and symptoms both during and after pregnancy.
The USPSTF also pointed to evidence indicating that certain patient populations are more likely to experience — and die from — an HDP. The task force said structural and interpersonal racism are among the causes of this inequity, noting that racism can produce disparities in social determinants of health such as education levels, environmental exposures, income levels, nutrition and stress. The draft recommendation and draft evidence review called for more research on disparities and suggested immediate steps that could help, including
- telehealth and remote monitoring during prenatal and postpartum care;
- establishing connections to community resources in the perinatal period;
- collaborative care in medical homes; and
- multilevel interventions to address underlying health inequities.
The task force also suggested that health care systems could address racial and ethnic inequities by providing better support during pregnancy for at-risk populations and increasing clinician awareness of which populations have higher risk of HDPs.
“We are using this draft recommendation statement to call attention to the inequities related to hypertensive disorders of pregnancy,” said Wanda Nicholson, M.D., M.P.H., M.B.A., the task force’s vice chair. “While taking blood pressure throughout pregnancy is an important first step, screening alone cannot fully address these inequities.”
Comments on the draft recommendation and draft evidence review are open through 11:59 p.m. ET March 6.
AAFP Resources and More
The AAFP offers members resources on HDPs and related topics, including
- AFP by Topic collections on labor, delivery and postpartum issues and prenatal care;
- patient care pages on maternal health and breastfeeding;
- links to more than two dozen clinical recommendations and guidelines on maternity care; and
- a recent edition of FP Essentials that features a section on HDPs along with information on hypertension in adults, children and adolescents.
The Women’s Preventive Services Initiative, a longstanding Academy partner, has also published several recommendations and resources for timely, high-quality patient care during and after pregnancy.
The USPSTF published a consumer guide that explains this draft recommendation. It also has related recommendations on aspirin use to prevent preeclampsia and related morbidity and mortality, as well as on screening for gestational diabetes, elevated blood lead levels in children and pregnant patients, hepatitis B and syphilis infection in pregnancy and bacterial vaginosis to prevent preterm delivery.